Dental Implants…Why not have a bridge instead?

A traditional bridge involves grinding down adjacent teeth into pegs to support the bridge. It is a stable solution with average esthetics and function that is fairly easy to make. However, this alternative has two main disadvantages: continuous bone loss in the missing area, and sacrificing healthy teeth on behalf of the bridge.

The teeth that are ground down on each side are much more susceptible to cavities and root canals. The average bridge only lasts 7-10 years. Often when the bridge fails, one or both of the ground down teeth is lost.

The next time the bridge is made, another tooth may have to be ground down to a peg to support the new bridge. This is the most aggressive, but yet most common way a single tooth is replaced. Most patients that had their teeth ground for a bridge regret it later in life. A bridge and an implant are about the same cost. In the long-term the bridge will end up being replaced several times in your life.

In this picture shown above, this patient is only missing two teeth! So in order to replace just the two center teeth, four other teeth had to be ground down. Two implants to replace the front teeth would have avoided the need for involving any of the other teeth. A two tooth problem, is now a six tooth problem!
Here is another one:
Three teeth ground down to replace just one!

23 thoughts on “Dental Implants…Why not have a bridge instead?”

I’m in need of some advice, and was recommended your site! I had a root canal at age 12 on on top left molar. At age 25, I had it re-done. I’m now 28, and after numerous infections on the tooth, have finally thrown in the towel – the re-treatment seems to have failed, and it looks like I’ll need to extract the tooth to stop these recurring infections.

As to what to do after the extraction – I’m aware I have 2 real options; an implant or a bridge. I’ve read extensively here and elsewhere about the pros and cons of the implant, and that was my natural first choice. However, after some additional x-rays, it looks like the tooth roots are in my sinus and it will likely involve a sinus lift and/or bone graft.

I went in search of a second opinion, and was told that perhaps in this case, a bridge would make more sense. The invasive surgery required to make an implant work may not just be worth it – essentially, that the tooth just wasn’t a great candidate for an implant. It COULD happen, with lots of finagling and bit and bobs and back and forths and months & months of procedures, but the risks of failure would be higher than a quick, traditional implant. As well, the two teeth adjacent to the affected tooth both have quite large fillings, which apparently make it an okay candidate for a bridge.

I’m just wondering – does this all seem reasonable? I do understand that implants are almost always ideal, but what situations exist that would make them not good options?

And – is this one of those situations, where a bridge may actually be a better option?

A bridge may very well be the best option for you but of course I have never seen or evaluated your unique situation. Some of the information you have been told may be based on that particular providers experience with dental implants. Meaning for some dentists, these procedures are so unusual that they cannot really tell you with any degree of certainty a success rate. In my practice doing a lateral window or internal sinus lift would be a daily event with a high degree of success and not lot of fanfare to make it work.

Unless your case is very unique, a sinus lift is not an invasive procedure.

Keep in mind that the teeth that are anchored to a dental bridge often end up with root canals and cracks. Usually within 7-10 years a bridge in the back of the mouth will fail from recurrent decay around the edges. At that point you may end up losing those teeth in having a more complex dental implant reconstruction then your even considering at this point.

I would suggest a third opinion before you making any irreversible decisions. If the tooth is still present, a well done socket preservation bone graft at the time of extraction will help reduce the invasiveness of the sinus procedure that will be needed after the tooth is removed.

I find that most patients that end up having Bridges done in the back of the mouth regret that they did not have an implant the first time.

YES…definitely. A connective tissue gum graft will help bulk out the missing tooth area for it to look very good. This will allow you to possibly have what we call an ovate pontic…. These look much better!!

yes you have the idea. You can subside over time but typically if the graft is done with connective tissue they tend to be very good. Sometimes you need a combination of a bone graft plus a connective tissue gum graft in order to form the ovate pontic that we discussed before. Yes, you would need to floss on this interface using a floss threader. The design is the most key element after having plenty of gum and bone to do this.

Hello. I’m not sure if I should get implants or root canals. My top upper right molar has already be extracted. I need a root canal on molar 14, next to where the previous molar was. I also need a root canal on tooth 31 and a crown on 30. I’m currently being treated for an abscess on tooth 31 and on antibiotics. This molar had a cavity filled previously and I don’t believe there would be a substantial amount of tooth left to build on as it has already been drilled on. The cost for both root canals is around $5000. Would implants in these areas be more beneficial and cost friendly?

If the teeth can be predictably restored with a good long-term prognosis than I would suggest you keep them. If the prognosis is questionable at 10 years post treatment, you may consider extraction and replacement with a dental implant. Be sure to see a very skilled and knowledgeable dentist that has your best interest in mind for a good long-term outcome. You can also have these teeth evaluated by 3-D scan which will help make the decision easier.

Dear Dr. Ramsey A. Amin, D.D.S,
My mom (73) is in need of “new” permanent dentures. The old ones are being replaced due to infections, and bone loss. Her dentist had to, unfortunately, remove the “permanents”, which was a task and clean up the mess. In order to accomplish this procedure, she had much needed bone graphing.
She really didn’t have good dental hygiene as a child.

Anyway, she now has the renewed choice of making a decision to go with a locator denture or a fixed implant bridge.

I like the way that you put the word new in quotations….. Permanent is a very strong word!! The other keyword that you used is “dentures”. There is no such thing as “permanent dentures.”

Overdentures and “permanent dentures” are all made of plastic. They wear out and need to be replaced. They often trap a lot of plaque which leads to bone loss. My suggestion would be to have a fixed dental implant bridge such as the Prettau which is NOT plastic acrylic.

This solution is as close to “permanent” as it can be as long as the dental implant and the bone are in excellent condition.
A plastic over denture will also wear out is often replaced after 7-10 years. Sometimes it is a personal decision or a financial decision to do an overdenture rather than fixed dental implants though.

I have a top and bottom partial but my other teeth are bad due to medications. I think I can deal with a full top denture, buy my lower has been a nightmare and I suspect even worse when I get the denture.
Am I understanding that Dr. Amin is saying that there is an alternative to try prior to going the implant route. Sorry but I couldn’t understand if they were two separate or one procedure.
I am in Texas and would definitely prefer you to work on me. A few years ago I was commuting to Burbank to tape a TV chat show for a new network. One day while taping I lost a front cap. Your office fit me in and was in and out within two hours and able to continue taping. The entire staff loved you …the crew because they were only slightly late and the executives who were going to have to pay a ton of overtime.
I will always appreciate that.

You must determine if your lower teeth are savable by predictable methods and that they will last more than 5-10 years using conventional treatment such as root canals and crowns. Oftentimes the teeth have been restored and re-restored so many times that there is very little tooth structure left and there is bone missing. If there are other areas of missing teeth in the same arch, it may be more cost effective and yield a more cosmetic and long lasting result to extract and replace all the teeth on the lower.

Each situation is very unique in must be evaluated carefully. Many patients and my office opt to have a Prettau dental implant bridge. This must be extremely carefully planned and executed for it to turn out right. Do not be fooled by imitations or people claiming they can do the same for a very low price. You would not imagine how many times a have to redo this procedure for patients who already have spent thousands of dollars.

Where can I get a copy of The fellows of the American Academy of implant dentistry here in San Diego ZIP Code 92128 or close by North County In land or North County coastal San Diego thank you. Mike. Borer

My mouth looks very similar to the picture showing 2 missing teeth with 4 others ground down. In my case, only one eye tooth is ground down and the other is fine. Can/should 1 permanent implant be joined/abutted to my 2 eye teeth?

Connecting a dental implant to a natural tooth is almost never a good idea. The dental implant and the natural tooth move it to different rates and dimensions. As they move, the seal is broken on the natural tooth and bacteria get under the margin.

The bottom line is that the teeth and up getting cavities because of a difference in this movement. Connecting dental implants to dental implants is fine, just tried to avoid connecting a dental implant to your own tooth. It is done in very rare instances and used to be done more in the 1970s but there were so many failures, that most people don’t do it anymore.

Find an experienced and credentialed dental professional in your area. AAID credentialed members are actively engaged in active practice incorporating dental implants. Following are explanations of the credentials:

Associate Fellows (AF) have been certified by their peers and have met national standards of education and practice in oral implantology.

Academic Associate Fellows (AAF) are dentists who are employed as faculty or administrators by accredited dental schools on a full time basis and who are involved in the discipline of implant dentistry.

Fellows (F) have been certified by their peers and have met national standards of education and practice in oral implantology. Due to the more extensive experiential requirements for Fellow Membership, Fellows are required to demonstrate advanced knowledge and experience in implant dentistry.

Diplomates (D) are AAID members who have become Diplomates of the American Board of Oral Implantology/Implant Dentistry (ABOI/ID). The ABOI/ID is a certification agency that serves independently to protect members of the public who seek dental implant care. The designation signifies that these dentists have met the highest criterions in oral implantology – they have met educational and experiential standards; and, they have reached an in-depth level of knowledge and acquired a proficient level of skill and ability.

Please answer my question. What would be the best option? Dental bridge or implant? I already have a bridge but I’m planning to replace it because it appears so big and bulky and I’m not satisfied with the outcome. Please reply

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive
experience in surgical and
restorative implant dentistry.
As one of only less than 400
Diplomates of the American
Board of Oral Implantology/
Implant Dentistry (ABOI/ID)
he is considered an expert,
and board-certified in dental
implants. He is a former
instructor at the UCLA School
of Dentistry.

This website provides dental information and is intended only to assist users in their personal search for a dentist. You are urged to seek the advice & consultation of a professional before undergoing any procedure. This site is intended for use only by healthy adult individuals. The site is not intended for use by minors, or individuals with any type of health condition. Such individuals are specifically warned to seek professional medical advice prior to undergoing any dental procedure.